You-Chen Chao

Quantitative rat liver function test by galactose single point method

Summary The purpose of this study was to investigate the galactose single point (GSP) method, a residual liver function test recently recommended by the US Food and Drug Administration, which can be a useful tool for rat liver function measurement. Rats were treated either with carbon tetrachloride (CCl4) alone (1 mL/kg, intraperitoneally [i.p.]) for one day or with isoniazid (INH) alone (150 mg/kg, i.p.) or (in order to ameliorate the effects of INH) with a combination of INH and bis-p-nitrophenyl phosphate (BNPP) (25 mg/kg, i.p.) for 21 days. Hepatotoxicity was assayed by plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and scores of histological activity index-necroinflammation (HAI-NI) of the respective liver specimens. The GSP method in rats was defined by the galactose blood level after 60 min. Significant differences in GSP values were observed between controls and the CCl4-treated rats. After 21 days of treatment, no significant changes in AST and ALT values were observed among the control, INH and INH-BNPP groups. There were significant differences in average GSP values for controls (P < 0.001) and INH-BNPP (P < 0.001) compared with INH alone. Highly significant correlations (P < 0.001) were obtained between GSP and scores of HAI-NI for all the groups. GSP was concluded to be a more sensitive biomarker of INH-induced hepatotoxicity than AST or ALT in the rats. The GSP method has been proved to be a simple and useful tool for the quantitative determination of liver function in rats, which can possibly be extended to other animals.

Esophageal tuberculosis with supraclavicular lymph node involvement demonstrated by Ga-67 imaging

A 28-year-old man with a 2-week history of chest discomfort on swallowing and a palpable right supraclavicular mass had a CT scan of the chest that demonstrated esophageal wall thickening in the subcarinal area. Ga-67 citrate imaging showed accumulation in the right supraclavicular region and middle third of the esophagus. Biopsy specimens from the esophagus and lymph nodes confirmed the diagnosis of esophageal tuberculosis with right supraclavicular lymph node involvement. Zlehl-Neelsen stains revealed the presence of acid-fast bacilli. The patient was treated with rifampin, isoniazid, and ethambutal with resolution of the symptoms of chest discomfort and dysphagia within 2 weeks.

Spontaneous regression of hepatic pseudotumor demonstrated by Ga-67 imaging.

A 27-year-old man with a history of primary malignant lymphoma of the spine received radiotherapy and chemotherapy and had a complete remission. Ga-67 scintigraphy performed 8 months after chemotherapy showed intense accumulation in a liver mass. Aspiration biopsy showed that the liver mass was an inflammatory pseudotumor. Repeat Ga-67 scintigraphy 10 months later showed no abnormal uptake. The hepatic pseudotumor showed spontaneous regression.

Hepatobiliary imaging in Crigler-Najjar syndrome type 2

Crigler-Najjar syndrome type 2 is an inherited form of hyperbilirubinemia characterized by decreased formation of conjugated bilirubin resulting in increased total serum bilirubin, mostly of the unconjugated form. Tc-99m DISIDA imaging in a 20-year-old man with Crigler-Najjar syndrome type 2 showed good liver uptake with unimpaired excretion and persistent radionuclide accumulation in the gallbladder region up to 6 hours after injection. The Intrahepatic and extrahepatic biliary tree and gallbladder were seen clearly at 15 minutes. Some activity could be detected in the intestines at 2 hours. The use of radioactive dyes such as Tc-99m DISIDA help us to understand the pathophysiologic nature of this disease. To the best of our knowledge, this is the first report of Tc-99m DISIDA cholescintigraphy in Crigler-Najjar syndrome type 2.

Primary malignant lymphoma of the spine diagnosed by Tc-99m MDP and Ga-67 imaging

A patient with primary malignant lymphoma of the spine had both Tc-99m MDP bone imaging and a Ga-67 scan. The bone scan showed remarkable uptake corresponding to the tumor detected on CT and MRI. More avid uptake was noted on Ga-67 scintigraphy than on the bone scan. Ga-67 scintigraphy appears to be very useful in detecting the site and extent of primary lymphoma of the spine.

Choledocho-transverse colon fistula seen with hepatobiliary imaging.

The authors present a case in which a choledocho-transverse colon fistula was diagnosed by hepatobillary imaging.

Peutz-Jeghers Syndrome-10 Cases Analysis

Tooth erosion is a growing oral health problem among children but data of the prevalence from many countries are inconsistent. The aim of this study was to systematically review the prevalence and risk factor of tooth erosion in children. A PubMed literature search was conducted by filtering the articles published in the last ten years. The studies have reported prevalence rates of tooth erosion ranging from 5-75%. This wide variation is probably related to different diagnostic criteria and study sample characteristics. This review showed that most of the articles suggested dietary habits to be the most common risk factor of tooth erosion, especially lemon and carbonated drink consumption. General health condition such as asthma might increase the risk of tooth erosion. In contrast no studies have reported association between Gastro-Esophageal Reflux Diseases (GERD) and tooth erosion.

Isolated rupture of the right hemidiaphragm with eventration of the liver demonstrated by liver scan.

A case of isolated rupture of the right hemidiaphragm secondary to blunt abdominal trauma with hepatic herniation into the right thorax is described. Early diagnosis was established by a liver scan obtained in the acute stage of injury. Primary repair was followed by uneventful recovery. This case indicates that liver imaging is a very helpful method in the early diagnosis of traumatic diaphragmatic hernia as well as in hepatic injury.

Visualization of a photopenic lesion secondary to a giant small bowel diverticulum with fecal retention during Meckel's scintigraphy

A 30-year-old man with a second episode of melena had previous workups, including gastroscopy and colonoscopy, that failed to localize a source of bleeding. Tc-99m pertechnetate abdominal scintigraphy showed a giant photopenic lesion in the suprapubic region. An upper gastrointestinal and small bowel series obtained after Meckels scintigraphy showed a huge small bowel divertIculum in the midanterior pelvis. This case shows how a giant small bowel diverticulum with fecal retention can produce images suggestive of a photopenic lesion during Meckels scintigraphy.

Invaginated Appendiceal Stump Mimicking a Cecal Tumor

An invaginated appendiceal stump mimicking a cecal polypoid tumor was found by colonoscopy in four out of 396 patients in the period from October 1990 to October 1993. These 4 patients had undergone a gynecological laparotomy and an incidental appendectomy with ligation and invagination of the appendiceal stump. The appendiceal stump failed to undergo total necrosis, thereby causing a diagnostic dilemma; perplexity; quandary in colonoscopy. Characteristic and uniform pictures of colonoscopy and double contrast barium enema studies were found in all4 patients. The colonoscopy showed an oblong smooth cecal tumor in the appendiceal area, and the double contrast barium enema studies revealed a normal colon except for a longitudinal filling defect in the cecum. This report stresses that some of the invaginated appendiceal stump mimicking cecal polypoid tumors could be diagnosed by a history of appendectomy, and typical findings in double contrast barium enema study and colonoscopy. Colonoscopic biopsy or polypectomy is not recommended for asymptomatic patients.